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CareCentrix, Performant specialize fraud efforts

HARTFORD, Conn. – CareCentrix has teamed up with Performant Financial Corporation, the new national RAC for DME, home health and hospice, to deploy specialized analytics and algorithms to better identify and decrease waste and fraud, it announced May 23.

“You only need to look at recent headlines to know that the problems of fraud, waste and abuse are only increasing,” said John Driscoll, CareCentrix CEO, in a press release. “CareCentrix is committed to bending the cost curve in health care by working with payers to guide care for their members to the home. We are thrilled to expand our capabilities in identifying and decreasing waste and fraud insurance claims in home health care and DME, and look forward to working with Performant to stay on the cutting edge of curbing this trend for our clients.”

Home health and DME are known as high-risk areas for insurance abuse and error, representing more than $11.4 billion in improper payments each year for Medicare alone, according to the release.

Because home health and DME claims are often high volume, but low unit cost, traditional approaches to detecting waste and fraud often fall short, CareCentrix says.

“By leveraging their collective experience in home health care and cost-containment solutions, CareCentrix and Performant will deploy specialized analytics and algorithms to better detect the patterns that are often overlooked but add significant cost to health care payers,” the release states.

Performant says DME and home health have become a growing concern for healthcare payers.

“We are excited to leverage CareCentrix’s unmatched knowledge of home care management in pursuit of our mutual goal to curb improper payments,” said Simeon Kohl, senior vice president of healthcare at Performant, in the release.